DOI: 10.4103/ijptr.ijptr_1_26 ISSN: 2666-3481

Association between Tibial Torsion and Navicular Drop among Patients Diagnosed with Knee Osteoarthritis Using American College of Rheumatology Guidelines: A Cross-sectional Correlational Study

Yogesh Sunil Khairmode, Deepak B. Anap, Saqib Syed
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Abstract

Background:

Knee osteoarthritis (OA) is often influenced by altered lower-limb alignment. Distal factors such as tibial torsion and foot pronation may change how forces travel through the knee. Earlier research in non-OA groups suggests that greater internal tibial rotation is linked with increased navicular drop, indicating more foot pronation (Eslami 2014; Karimi 2013). Recent studies also show that people with knee OA commonly display more pronated feet (Levinger 2010; Gosavi 2021) and torsional alignment changes (Kim 2023). However, this relationship has not been well explored in patients clinically diagnosed with OA using American College of Rheumatology (ACR) guidelines. Understanding this connection may help clinicians recognize modifiable foot–ankle factors that contribute to knee pain.

Methodology:

A cross-sectional observational study was conducted on 20 adults clinically diagnosed with knee OA according to the ACR criteria. Tibial torsion was assessed bilaterally using the clinical goniometric thigh–foot angle method, and foot pronation was measured using the navicular drop test. All measurements were performed under standardized conditions by a single examiner to enhance reliability. Descriptive statistics were calculated, and the relationship between tibial torsion and navicular drop was analyzed using Pearson’s correlation coefficient. Statistical analysis was performed using GraphPad Prism, with significance set at P < 0.05.

Results:

On the left side, the mean navicular drop was 13.15 ± 2.18 mm and the mean tibial torsion was 24.75 ± 2.55°. A moderate positive correlation was observed between the two variables ( r = 0.4038), although it did not reach statistical significance ( P = 0.0774). Despite this, the trend suggested that greater tibial torsion was generally accompanied by increased foot pronation. On the right side, where most participants reported higher Numerical Pain Rating Scale pain scores, navicular drop (14.05 ± 2.8 mm) and tibial torsion (25.5 ± 3.52°) were slightly higher. A statistically significant positive correlation was found between the two measures ( r = 0.6120, P = 0.0041). This indicates a clearer relationship between transverse-plane tibial alignment and foot pronation on the more symptomatic limb. Overall, the findings demonstrate a consistent positive association between tibial torsion and navicular drop, particularly on the painful side. These results support the idea that altered distal alignment may become more evident with symptom severity and could play a meaningful role in the biomechanical presentation of knee OA.

Conclusion:

This study found that on the painful side, higher tibial torsion was clearly linked with greater navicular drop. In simple terms, when the tibia twists more, the foot tends to collapse or pronate more. This suggests that changes at the foot and ankle may play a meaningful role in knee OA symptoms. Assessing and correcting these distal alignment issues through exercises or pronation-control strategies may help in OA management. Larger studies with healthy controls are needed to strengthen these findings.

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